Nearly four years after the COVID-19 pandemic shut down much of the world, Dubuque health care leaders continue to fight ongoing workforce challenges that are prompting providers to find creative solutions to complex problems.
While providers said the industry’s workforce shortages were worrisome before 2020, they agree the pandemic only exacerbated preexisting problems.
Factors such as health care workers retiring en masse, a rapidly growing older-adult population, higher pay in other careers and the many health care jobs available in the tri-state area all compounded with the economic impacts of the pandemic to create what one local hospital official calls a “perfect storm” of challenges.
Left in its wake are providers investing heavily in recruitment and retention initiatives and appealing to lawmakers for help and awareness of the issue.
Peggy Stockel, president and CEO of Stonehill Communities in Dubuque, said challenges in the health care workforce existed prior to 2020, but the pandemic made a difficult situation worse.
“Workforce is a huge, major concern,” Stockel said. “It should be for all of us, honestly, because for people who are accessing care, it’s going to delay that.”
Staffing issues ‘concerning’
Kay Takes, president of MercyOne Dubuque Medical Center, pointed to several factors that collectively are feeding into health care staffing issues, not just at MercyOne but nationwide.
Many health care workers quit or retired early during the height of the pandemic, she said. And more retirements are expected as the baby boomer generation ages, with about 46.7% of active physicians in the U.S. at least 55 years old as of 2021, according to a 2022 Association of American Medical Colleges report.
Despite shrinking workforce numbers, Takes said, the number of people needing care only will increase as the population of people at least 65 years old is projected to be 80.8 million by 2040. That is nearly double that group’s size in 2000, according to a 2021 report by Administration for Community Living, an operating division of the U.S. Department of Health and Human Services.
“It’s kind of a perfect storm, I think,” Takes said, “In health care, specifically, because of the aging population, the workforce issues are even more concerning.”
The nature of health care jobs also creates challenges in hiring, according to Tracy Bauer, president and CEO of Midwest Medical Center in Galena, Ill.
Hospitals operate 24/7, including on holidays, but are competing for staff with outpatient clinics that often are open for regular business hours, she said. While that always has been a struggle, she said the drop in workers caused by the pandemic made it worse.
Bauer said staffing challenges also have made it harder for Midwest Medical Center to transfer emergency room patients when they need a higher level of care. She said facilities often have open beds but not enough staff.
“Sometimes we’re calling up to 25 hospitals looking for a bed to transfer one of our patients to,” Bauer said.
Jack Mescher, CEO of Hills & Dales in Dubuque, said the nature of the nonprofit’s operation also limits his use of typical business strategies to improve workforce conditions.
Because Hills & Dales, which serves people with disabilities, is funded mostly by Medicaid, raising prices isn’t an option without reimbursement rates changing. Because patients need care all hours of the day, shortening operational hours is also not a money-saving solution.
“All the levers that are available to other aspects of the economy are really not available,” Mescher said. “Absent some investment or real capacity building solutions, it’s just not tenable to move forward in an efficient way.”
Dubuque’s unique challenges
Dubuque and the surrounding area have no shortage of health care facilities.
With two major hospitals in Dubuque, a variety of clinics, nursing homes and nearby critical access hospitals, providers agree the area’s many health care options are an asset. However, with more providers come more jobs to fill.
Mescher said Dubuque has been unable to build a larger pool of health care workers, which results in providers constantly pulling staff from other providers.
“Every provider is a critical piece of the health care infrastructure,” Mescher said. “But because of the lack of health care population workforce, we really aren’t effective at building capacity because we keep passing it around.”
For the amount of funding, time and resources Hills & Dales spends trying to recruit and retain talent from other providers, Mescher wants to find a way to use those dollars to increase the pool of workers in the area so each location has enough employees.
“The clients and residents of Hills & Dales really need a primary care physician at a local clinic, and they really need a nurse for that physician. But they also need a nurse at home, and they also need a nurse if they have to go to the emergency department, and they also need a nurse to staff the mental health unit,” Mescher said. “It’s painful to be recruiting from resources that you need.”
Multiple critical access hospitals are located within a 30- to 40-mile radius of Dubuque’s two major hospitals. Critical access hospitals are designated by states and aim to provide essential emergency care in rural areas where residents otherwise would have to travel a longer distance.
Typically, these facilities must be more than 35 miles away from another hospital. However, there are four such facilities within 35 miles of Dubuque’s hospitals: MercyOne Dyersville Medical Center and Jackson County Regional Health Center in Iowa; Southwest Health and Grant Regional Health Center in Wisconsin; and Midwest Medical Center in Galena, Ill. And Guttenberg Municipal Hospital & Clinics in Iowa and Memorial Hospital of Lafayette County in Darlington, Wis., are just outside that 35-mile radius.
Rick Dickinson, president and CEO of Greater Dubuque Development Corp., said because critical access hospitals have higher Medicare reimbursement rates, they have a competitive edge in wages. Dickinson said Medicare reimbursements should be increased across the board in Iowa.
“There’s some challenges that are unique to Iowa and Dubuque in particular, given our proximity to Illinois and Wisconsin and the critical care facilities that are just across the border in a different state,” he said.
However, Southwest Health Chief Administrative and Financial Officer Jesse Sookochoff said only about 10.5% of the hospital and clinics’ employees reside in Iowa. He said the higher Medicare reimbursement rate isn’t necessarily an advantage for Southwest Health and that a hospital’s success depends on a variety of factors.
“The bottom line is, there isn’t a correlation between federal and state reimbursement and Southwest’s ability to hire and retain quality staff,” Sookochoff said.
Bauer said the higher Medicare reimbursement simply allows Midwest Medical Center to be viable in the market.
“There’s a place for all health care facilities in this area, and it’s much needed because if we weren’t here, I don’t know where these patients would be going for services,” Bauer said.
Despite ongoing issues industrywide, UnityPoint Health-Finley Hospital Market President Jennifer Havens said Dubuque is not worse off than any other market nationwide.
“Our data does indicate locally and within our health system and across the state that we are seeing some improvements in this area,” Havens said. “I wouldn’t characterize the workforce problem in Dubuque being particularly different than it is in Madison, Iowa City, Waterloo, Cedar Rapids, et cetera.”
Havens said Finley continues to closely monitor job openings and is focused on retaining quality employees. The key to that, she said, is creating a culture and environment where employees feel respected and heard.
Tapping into education
To move toward improving workforce shortages, many providers see education as a key piece of the puzzle.
Stonehill Communities Director of Health Services Matt Jahn said he speaks with students as young as seventh and eighth grade about potential careers in health care.
“I talk about all the different disciplines that make up our health care team and all the people that we rely on to work collectively together to really provide the best care and experience for the people that we’re caring for,” Jahn said.
Stonehill also partners with Northeast Iowa Community College to host certified nursing assistant courses on its campus. Once someone obtains a CNA certification, Stonehill continues to support career progression through scholarships so staff can obtain further education, Stockel said.
“We build that career pathway for them, and we help pay for it,” Stockel said. “We grow our own.”
Bauer said Midwest Medical Center also offers a scholarship program that pays for participants’ CNA certification if they work for the hospital. Bauer said the hospital also has stepped up marketing and wages and benefits to remain competitive.
“The reality is, we all have to be working with our local education systems,” she said. “Even (registered nurse programs) are still sometimes a wait to get into, whether it’s a two-year or four-year program. We have to have more schools willing to open up their programs to allow as many students into them as possible.”
Jennifer Nutt, vice president of nursing and clinical services for Iowa Hospital Association, said kids should be learning about the importance of health care workers as early as kindergarten in order to grow the pipeline of employees.
Area colleges also have a part to play in increasing the number of health care employees locally.
About a year ago, Southwest Wisconsin Technical College in Fennimore, Wis., announced a partnership with six area hospitals where each hospital pledged $75,000 for nursing students’ tuition, additional nursing faculty and other student support.
Loras College in Dubuque last year announced plans to launch a program that will allow students to earn a bachelor’s degree from Loras and a Bachelor of Science in nursing through an accelerated pathway from Mercy College of Health Sciences — adding to the list of options available to earn health care degrees at local colleges. University of Wisconsin-Platteville officials last year entered an agreement with University of Wisconsin-Oshkosh to similarly help students earn nursing degrees from UW-Oshkosh while remaining in Platteville.
Also last year, Clarke University, Loras College and University of Dubuque announced plans to launch the Dubuque Promise Program, which will award funds to students who commit to remain and work in the tri-state area for two years after graduation. The program initially was opened to students from the Dubuque area majoring in several areas, including nursing.
Jackie Meyer, head of UD’s nursing department, said the school focuses on ensuring students have a smooth transition to the workforce to keep nurses in the profession. Students intern at a partnering hospital during their last semester of school and complete three 12-hour shifts at a rural hospital.
“We lose a lot of nurses in that first year or two, if they’re not prepared for practice,” Meyer said. “There’s a lot of burnout and stress and exhaustion that can come with the shock of that professional transition.”
Havens said in an emailed statement that Finley has launched several initiatives over the past few years to combat the workforce shortage.
Besides increased and additional bonuses, Finley has introduced multiple programs aimed at supporting and recruiting students, such as the Senior Student Promise Program, which covers tuition and offers sign-on incentives to graduating clinicians.
Takes said apprenticeships are also an important part of how MercyOne brings in staff for hard-to-fill roles as they allow employees to learn on the job.
“People can come into our central sterilization department as a (central sterilization) colleague and then articulate into a surgical technician role, which is a hard-to-recruit position,” she said.
Legislative options
Beyond bolstering the workforce through education, many providers cited culture, work-life balance and schedule flexibility as major factors in employee retention.
Another point of focus for many providers is appealing to the state Legislature for more sweeping changes. Takes said she would like to see incentives for health care employees such as student debt- and tax-relief programs that could keep more employees in the industry.
Iowa Sen. Pam Jochum, D-Dubuque, a member of the Iowa Senate Health and Human Services Committee, said in a message to the Telegraph Herald that there is no quick fix or single solution to the health care workforce shortage.
Among other changes, she said, wages need to be more competitive with surrounding states, health professionals who work in underserved areas should be eligible for loan forgiveness and there should be more residency placements for medical students.
Expanded educational opportunities and affordable child care are also necessary, Jochum said. For nursing homes and similar facilities, increases in Medicaid funding should be tied to increasing the wages of the direct care workforce, she said.
“Last but not least, there needs to be an investment in public health from outreach to prevent patients from needing acute care to expanding wellness and health campaigns in schools, educating children and families on healthy lifestyle choices to combat child obesity and promote early childhood wellness,” Jochum said in her message.
Iowa Rep. Steve Bradley, R-Cascade, a member of the Iowa House of Representatives Health and Human Services Committee, said two relevant pieces of legislation he is working on this session include a bill that would allow radiologists in rural areas to receive tuition reimbursements from the state and a bill that would bar licensure applications for ambulatory surgical centers from having more requirements than Medicare or federal accrediting organizations.
Bradley, who is a dentist, also said he always is focused on increasing Medicaid reimbursement rates for dentists.
“I’ve been lobbying for that for 20 years, especially in the last 10 years,” Bradley said.
Dickinson said efforts need to be made on a federal level to ensure providers are getting enough funding to increase wages and retain employees.
“I think that solution has to be federal and it has to be based on Medicare reimbursements in particular,” he said.
Besides options such as using international workers and alleviating administrative work, Mescher said solutions are a daunting task. He said the system needs to be reworked to function more effectively and ensure providers can maintain a high level of care.
“I would say something pretty robust needs to be done in a methodical way to really correct this,” Mescher said. “And I think if we don’t find a way to do that methodically, sooner than later, it will come to a head that requires less efficient reaction or more disruptive reaction.”
Nutt said considering what the staffing situation has been for the past few years, hospitals continue to find innovative ways to not only recruit staff but also provide quality care despite struggles.
“They’re doing the best they can with what they have,” she said. “They’re really streamlining to make practices better so we can maintain high quality in the state of Iowa.”
